{
  "abstract": "Abstract Objective To evaluate the clinical effectiveness of the YCMAP intervention (Youth Culturally Adapted Manual Assisted Problem Solving) for adolescents after self-harm in Pakistan.Design Multicentre, randomised controlled trial that compared YCMAP with enhanced treatment as usual.Settings General practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi.Participants Adolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021.Intervention The YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy.Main outcome measure The primary outcome was the repetition of self-harm at 12 months after randomisation. Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation. Participants’ satisfaction with the services was assessed at three and 12 months after randomisation.Results This trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342). The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006). YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months. YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.Conclusion The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents. Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.Trial registration ClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.",
  "authors": [
    {
      "affiliations": [
        "Division of Psychology and Mental Health, The University of Manchester School of Health Sciences, Manchester, UK",
        "Global Centre for Research on Mental Health Inequalities, Mersey Care NHS Foundation Trust, Prescot, UK"
      ],
      "name": "Nusrat Husain"
    },
    {
      "affiliations": [
        "Division of Neuro-Cognitive Disorder, Older Adults Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Sehrish Tofique"
    },
    {
      "affiliations": [
        "Division of Mood Disorder, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Tayyeba Kiran"
    },
    {
      "affiliations": [
        "Division of Psychology and Mental Health, The University of Manchester School of Health Sciences, Manchester, UK"
      ],
      "name": "Matthias Pierce"
    },
    {
      "affiliations": [
        "Division of Psychology and Mental Health, The University of Manchester School of Health Sciences, Manchester, UK",
        "Dr Ziauddin Hospital, Karachi, Pakistan"
      ],
      "name": "Imran B Chaudhry"
    },
    {
      "affiliations": [
        "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada",
        "Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "M Omair Husain"
    },
    {
      "affiliations": [
        "Science and Technology Studies, University College London, London, UK",
        "Manchester Global Foundation, Manchester, UK"
      ],
      "name": "Rakhshi Memon"
    },
    {
      "affiliations": [
        "Faculty of Health and Life Sciences, University of Liverpool, Liverpool UK"
      ],
      "name": "Ahmed Waqas"
    },
    {
      "affiliations": [
        "Division of Psychology and Mental Health, The University of Manchester School of Health Sciences, Manchester, UK"
      ],
      "name": "Nadeem Gire"
    },
    {
      "affiliations": [
        "Science and Technology Studies, University College London, London, UK"
      ],
      "name": "Sarah Edwards"
    },
    {
      "affiliations": [
        "Statsconsultancy, Amersham, UK"
      ],
      "name": "Paul Bassitt"
    },
    {
      "affiliations": [
        "Division of Biostatistics, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Suleman Shakoor"
    },
    {
      "affiliations": [
        "Division of Child and Adolescents, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Zainab F Zaddeh"
    },
    {
      "affiliations": [
        "Department of Evidence Synthesis, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Usman Arshad"
    },
    {
      "affiliations": [
        "Department of Psychology, Middlesex University, London, UK"
      ],
      "name": "Erminia Colucci"
    },
    {
      "affiliations": [
        "Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Australia",
        "NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK",
        "Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Faraz Mughal"
    },
    {
      "affiliations": [
        "Division of Mood Disorder, Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Samia Shahid"
    },
    {
      "affiliations": [
        "Division of Population Health, Health Services Research & Primary Care, Manchester, UK"
      ],
      "name": "Maria Panagioti"
    },
    {
      "affiliations": [
        "Institute of Psychiatry, Punjab, Pakistan"
      ],
      "name": "Asad T Nizami"
    },
    {
      "affiliations": [
        "Community Medicine, Karachi Medical and Dental College, Karachi, Pakistan"
      ],
      "name": "Farhat Jafri"
    },
    {
      "affiliations": [
        "Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Farooq Naeem"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK"
      ],
      "name": "Richard Emsley"
    },
    {
      "affiliations": [
        "Department of Psychiatry, Sir Cowasjee Jehangir Institute, Hyderabad, Pakistan"
      ],
      "name": "Moin A Ansari"
    },
    {
      "affiliations": [
        "Department of Applied Psychology, Bahauddin Zakariya University, Multan, Pakistan"
      ],
      "name": "Sarwat Sultan"
    },
    {
      "affiliations": [
        "IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia",
        "Centre for Adolescent Health, Murdoch’s Children’s Research Institute, Melbourne, Australia"
      ],
      "name": "Shilpa Aggarwal"
    },
    {
      "affiliations": [
        "School of Health & Wellbeing, University of Glasgow, Glasgow, UK",
        "Five Areas, Glasgow, UK"
      ],
      "name": "Christopher Williams"
    },
    {
      "affiliations": [
        "Pakistan Institute of Living and Learning, Karachi, Pakistan"
      ],
      "name": "Nasim Chaudhry"
    }
  ],
  "title": "Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial",
  "uid": "79d48d5f-fbcf-5578-8782-1b6f6fd6e70d"
}